Family Practice, Vol 15, 398-403, Copyright © 1998 by World Organization of Family Doctors
K Kroenke and JL Jackson
BACKGROUND: Although physical complaints account for over half of all
ambulatory visits, surprisingly little is known about their natural history
and factors affecting prognosis. OBJECTIVES: Our aims were to determine the
outcome in general medical patients presenting with physical complaints and
to delineate which factors impact upon recovery rates. METHODS: In this
cohort study, 500 adults presenting to a general medicine clinic with a
chief complaint of a physical symptom were interviewed in order to
determine symptom characteristics, the presence of depressive or anxiety
disorders, and expectations regarding the visit. Outcomes were assessed
immediately post-visit and at 2 weeks and 3 months. The primary outcome was
symptomatic improvement, and secondary outcomes included functional status,
unmet expectations, satisfaction with care and visit costs. RESULTS: The
majority (70%) of patients improved by 2 weeks follow-up and, of those who
had not, 60% got better within 3 months. Moreover, relapse in patients
initially better at 2 weeks was uncommon (6%) in the ensuing several
months. While symptoms of recent onset had the highest improvement rates,
half of those patients whose symptom had been present a year or longer also
improved within 2 weeks. Improvement rates varied somewhat by symptom type,
but no specific symptom had an improvement rate of less than 50%. Patients
who had not improved at 2 weeks were more likely to report continuing
serious illness worry, unmet expectations, functional impairment and
dissatisfaction, even 3 months after the initial visit. CONCLUSION: Most
general medical patients with physical complaints improve within 2 weeks of
their initial clinic visit. Further attention may best be focused on the
minority of patients who fail to improve and experience continuing concerns
and impairment.
ORIGINAL CLINICAL RESEARCH
Outcome in general medical patients presenting with common symptoms: a prospective study with a 2-week and a 3-month follow-up
Regenstrief Institute for Health Care and Department of Medicine, Indiana University School of Medicine, Indianapolis 46202, USA.
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